Increasing Evidence for Potential of Ketogenic Diets for Alzheimer’s Disease

I am eternally grateful to our sponsors who, by blogging, podcasting and advertising with us, enable me and my team to devote energy and time to writing and publication. All the companies who sponsor us are companies that I trust for myself and my patients and use regularly in my clinical practice. Please check out their websites! – Dr. KF

Ketones – in biochemistry years ago, we were taught that they were waste products: specifically, byproducts of fatty acid metabolism to be eliminated in urine with no real use. Of course, we now know that that idea was wrong, wrong, wrong. Ketones are remarkably bioactive molecules, produced in response to glucagon production under conditions of caloric restriction or very low carb diets. In our sponsored blog this month, provided by Designs for Health, Amy Berger takes us on a well-referenced tour of ketone bodies and their importance in Alzheimer’s disease. Can’t wait to hear what you think!

~ DrKF

DrKF Sponsored Content | Few illnesses are as frightening and feared as Alzheimer’s disease. It seems to strike indiscriminately, and the best conventional medicine has to offer are medications that are ineffective at slowing or stopping disease progression. Fortunately, a large body of research suggests we know more about this seemingly mysterious condition than we might think. There are still many unanswered questions and more research to be done, but it’s looking more and more like Alzheimer’s is a metabolic condition, with a metabolic solution. In looking at what’s going wrong in the Alzheimer’s brain, there’s more reason than ever to be hopeful that we can make a dent in this devastating illness.

Evidence continues to mount that a ketogenic diet may be an effective nutritional intervention for Alzheimer’s disease (AD) and its precursor, mild cognitive impairment (MCI). For those familiar with the pathology of these conditions, using a ketogenic diet is an elegant and scientifically sound way to fuel the brain. After all, the fundamental problem in this condition is that neurons in affected regions of the brain lose the capacity to harness sufficient energy from glucose. In some individuals with AD, the brain may be metabolizing as much as45% less glucose than the brain of a healthy person. For this reason—and others related to peripheral and cerebral insulin resistance, Alzheimer’s disease is often referred to as “type 3 diabetes.”

Alzheimer’s and Mild Cognitive Impairment are Energy Shortages in the Brain

MCI and AD can be thought of as “fuel shortages” or “energy crises” in the brain. In people following a mixed macronutrient diet, or a “standard American diet,” which is typically high in carbohydrates, glucose is a primary fuel for the brain. So, when affected neurons become unable to metabolize glucose, the logical outcome is precisely the kind of memory loss, confusion, personality changes, and behavioral disturbances seen in these conditions. What is too often relegated to biochemistry textbooks and research laboratories, and not talked about enough in the offices of neurologists and geriatricians, is that in people following a ketogenic diet,ketones can provide as much as 60% of the brain’s energy supply.

It’s important to note that the energy shortage in these forms of cognitive decline is specific to glucose. The brains of individuals with MCI or AD still take up and use ketones. This is why dramatic improvements have been observed in individuals with Alzheimer’s or MCI who follow ketogenic diets or take exogenous ketone supplements (in the form of beta-hydroxybutyrate esters or salts). Ketone entry into the brain, and then into neurons, is not impacted by alterations in insulin sensitivity and glucose transport that affect brain glucose uptake.

Alzheimer’s researchers are well aware of the powerful potential for ketones to supply abundant energy to the starving, atrophying brain in MCI and AD:

“…two points are clear – (i) AD is at least in part exacerbated by (if not actually caused by) chronic, progressive brain fuel starvation due specifically to brain glucose deficit, and (ii) attempting to treat the cognitive deficit early in AD using ketogenic interventions in clinical trials is safe, ethical, and scientifically well-founded.” (Cunnane et al., 2016)

“…the deterioration in brain energy metabolism is specific to glucose. These results suggest that a ketogenic intervention to increase energy availability for the brain is warranted in an attempt to delay further cognitive decline by compensating for the brain glucose deficit in MCI and AD.”(Croteau et al., 2017)

The ability of ketones to fuel a struggling brain would be enough of a reason for afflicted individuals to implement a trial of a ketogenic diet and/or experiment with exogenous ketones. But the benefits of a ketogenic diet for brain health go beyond simply providing an alternative fuel to glucose.

Beta-hydroxybutyrate (βOHB) has anti-inflammatory effects. This molecule “holds promise in reducing the severity of multiple NLRP3 mediated chronic inflammatory diseases,” with the NLRP3 inflammasome being a key promoter of the release of caspase-1 and the inflammatory cytokines interleukin 1β and interleukin 18. It’s currently unknown what, exactly, leads to the metabolic deficits that ultimately result in the cognitive decline observed in MCI and AD, but increased systemic and cerebral inflammation may contribute by altering or upregulating the immune response and potentially facilitating neuronal cell death.

By Amy Berger, MS, CNS

Designs for Health contributing writer, Amy Berger, MS, CNS, is a U.S. Air Force veteran and Certified Nutrition Specialist who specializes in using low-carbohydrate and ketogenic nutrition to help people reclaim their vitality through eating delicious foods, and showing them that getting and staying well doesn’t require starvation, deprivation, or living at the gym. Her motto is, “Real people need real food!” In addition to writing for DFH, Amy blogs at, www.tuitnutrition.com, where she writes about a wide range of health and nutrition-related topics, such as insulin, metabolism, weight loss, thyroid function, and more. She is the author of The Alzheimer’s Antidote: Using a Low-Carb, High-Fat Diet to Fight Alzheimer’s Disease, Memory Loss, and Cognitive Decline.

This is a form of diabetes that effects the brain. A diet high in carbohydrates/sugar foods eventually fails to properly use glucose as fuel. Without glucose, the neurons (cells in the brain) start to starve, which contributes to dementia symptoms.

I am eternally grateful to our sponsors who, by blogging, podcasting and advertising with us, enable me and my team to devote energy and time to writing and publication. All the companies who sponsor us are companies that I trust for myself and my patients and use regularly in my clinical practice. Please check out their websites! – Dr. KF

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The Sandy Hook Clinic (SHC) is located in the Sandy Hook Village section of Newtown, Connecticut in Fairfield County, Connecticut. The clinic is housed on the fourth floor of a rehabilitated old brick mill building, overlooking the Pootatuck River.